The present invention relates in general to a surgical accessory, and more particularly, to a two-piece retrievable catheter for replacement of a dislodged T-tube previously surgically implanted in the internal ducts or vessels of a patient as a conduit to stent and/or provide drainage after a surgical procedure, for example, the common bile duct following surgery to remove gallstones or the gallbladder itself.
The surgical implantation of a T-tube following surgery, in particular, open cholecystectomy, is well-known in the medical field as well as the patent literature. Typically, these T-tubes are made from a highly flexible material so that when their function is no longer needed, they may be removed by simply pulling them out of the patient. For example, Goldberg et al., U.S. Pat. No. 3,835,863, discloses a flexible T-tube which is surgically implanted in an internal duct or vessel of a patient in order to facilitate the removal of the T-tube when it is no longer needed. The T-tube includes a continuous slit extending longitudinally across the top of the cross tube. As the T-tube is pulled out from the patient for removal, the longitudinal slit causes the arms of the cross tube to telescope within each other to form a smaller cross-section which minimizes the amount of trauma and stress in the duct. T-tubes without a slit are known from Morales-George, U.S. Pat. No. 4,654,032 and Whelan, Jr., U.S. Pat. No. 4,142,528.
Hartenbach, U.S. Pat. No. 3,833,940 discloses a metal or plastic cannula which is surgically implanted in the bile duct of the patient. A radially extending nipple in communication with the interior of the cannula protects against the longitudinal displacement of the cannula and permits a drainage hose to be connected thereto. Optionally, one or both of the end sections of the cannula may be detachable from the nipple portion, thereby making the implantation of the cannula within a bile duct easier.
Swartz, U.S. Pat. No. 4,072,153, discloses a flexible T-tube for use as a fluid drainage tube following a hysterectomy. A large central drain port formed at the intersection of the cross tube and drain tube causes the arms of the cross tube to fold up on one another as the drain tube is pulled, thereby facilitating the withdrawal of the tube from the patient.
Jones, U.S. Pat. No. 4,248,224, discloses a double lumen flexible catheter having a generally Y or T shape formed at a distal end. A substantially stiff sleeve is slidably fitted over the cannula. As the sleeve is slid over the lower branch portions at the distal end of the catheter, it urges the branch members into alignment with the upper fluid conveying tube so the entire structure can be passed through a relatively small single surgical opening. Once properly positioned, the sleeve can be retracted so that the two branch members return to their Y or T configuration within the duct.
Grunwald, U.S. Pat. No. 4,309,994, discloses a flexible Y or T shaped cannula which is similar to that of Jones. The divergent ends of the cannula are straightened for insertion into the vena cavae of a patient by an elongated obturator slidably inserted therein. The obturator includes a straight body having two straight branches extending from one end thereof. As the obturator is slid into the cannula, the branches engage and straighten the branches of the cannula to facilitate the insertion of same into the vena cavae through a single surgical opening. Upon withdrawal of the obturator, the branches of the cannula will return to their normal Y or T configuration.
Patel, U.S. Pat. No. 4,748,984 discloses a catheter assembly for use in performing coronary angiography and angioplasty. The catheter consists of an elongate guiding portion having a tip portion pivotally connected thereto. A guide wire inserted into the guiding catheter and tip portion maintains these elements in alignment as the assembly is inserted into the patient's aorta. The guide wire is then removed and the guiding catheter maneuvered until the tip portion pivots to a position adjacent the tip of the guiding catheter. In addition, the tip portion of the catheter may be curved to form a loop.
In addition to the T-tube, it is also known that catheters having a straight configuration may be inserted into a patient over a guide wire. Once inserted, the guide wire is removed, and by pulling on a suture or series of sutures threaded therethrough, the tip of the catheter may be curled to form a loop or S-shape. When the catheter is no longer needed, the tension on the suture is relieved and the guide wire reinserted, thereby straightening the catheter for removal.
Despite these known medical devices and surgical procedures, replacement of a dislodged T-tube may be impossible or difficult, at best. Reinsertion of a soft surgical T-tube requires folding of the trailing limb and this doubled tubing may not pass through the undilated or tortuous T-tube tract. If the T-tube is dislodged early in the post-operative period, replacement may result in tract perforation and peritonitis. When retained common bile duct stones or obstructions from sticture or neoplasm are present, T-tube replacement is mandatory. If a T-tube cannot be replaced, biliary drainage catheters can be used, but these may leak, drain poorly or become malpositioned. Accordingly, there is an unsolved need for a T-tube catheter which can easily be placed percutaneously within a patient for replacement of a dislodged T-tube, particularly during the post-operative period.